Provider Demographics
NPI: | 1952578668 |
---|---|
Name: | MARION COUNTY HEALTH DEPARTMENT |
Entity Type: | Organization |
Organization Name: | MARION COUNTY HEALTH DEPARTMENT |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | ADMINISTRATOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | LORI |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | RYAN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 618-548-3878 |
Mailing Address - Street 1: | 118 CROSS CREEK BLVD |
Mailing Address - Street 2: | |
Mailing Address - City: | SALEM |
Mailing Address - State: | IL |
Mailing Address - Zip Code: | 62881-1920 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 618-548-3878 |
Mailing Address - Fax: | 618-548-3866 |
Practice Address - Street 1: | 118 CROSS CREEK BLVD |
Practice Address - Street 2: | |
Practice Address - City: | SALEM |
Practice Address - State: | IL |
Practice Address - Zip Code: | 62881-1920 |
Practice Address - Country: | US |
Practice Address - Phone: | 618-548-3878 |
Practice Address - Fax: | 618-548-3866 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2008-05-12 |
Last Update Date: | 2008-05-12 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251K00000X | Agencies | Public Health or Welfare |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
IL | ========= | Medicaid | |
IL | ========= | Medicaid |